Provider Demographics
NPI:1588338552
Name:KOERNER, ALEXANDRA LYNN
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:LYNN
Last Name:KOERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:DEETH
Mailing Address - State:NV
Mailing Address - Zip Code:89823-0057
Mailing Address - Country:US
Mailing Address - Phone:775-340-8580
Mailing Address - Fax:
Practice Address - Street 1:1900 DENNIS FLAT RD
Practice Address - Street 2:
Practice Address - City:DEETH
Practice Address - State:NV
Practice Address - Zip Code:89823-8982
Practice Address - Country:US
Practice Address - Phone:775-340-8580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVLABA431103K00000X, 106E00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician